An Overview of the 2009 H1N1 Influenza Vaccine Communication Environment and Cdc's Campaign Planning, Implementation, and Evaluation Efforts

Background: Soon after the emergence of the 2009 H1N1 influenza virus in April 2009, CDC scientists isolated and identified the novel virus and preparation began for development of a vaccine. CDC immunization and communication experts also began preparing to implement an unprecedented immunization program, including a campaign to encourage Americans to be vaccinated against the new influenza virus.  The effort to plan and implement a campaign to promote the H1N1 vaccine had to be done in coordination with parallel efforts to promote the seasonal influenza vaccine. 

Program background: CDC’s 2009 H1N1 vaccination communication campaign was planned in a dynamic and uncertain context. Initially, it was unknown if and when vaccine would become available, how it would be distributed, who would be recommended to receive the first available doses, and if there would be demand for the vaccine. Promotion of seasonal flu vaccine was used as a starting point and public health officials planned for a limited number of key scenarios based on varying levels of H1N1 vaccine availability and public demand for vaccination.

Evaluation Methods and Results: H1N1 influenza vaccine campaign plans and activities were informed by media monitoring and content analyses, focus groups with at-risk populations, in-depth interviews with immunization providers, public opinion surveys, website statistics and CDC hotline call inquiry summaries, as well as significant input from partners.

Conclusions: Planning assumptions were informed by CDC’s experience with promotion of seasonal influenza vaccines, management of past influenza vaccine shortages, and ongoing audience research. These assumptions included that vaccine supply would be unpredictable, public demand for vaccination would be impacted by when disease activity increased, severity and visibility of H1N1 influenza cases, the population groups most severely affected, beliefs regarding personal susceptibility to severe disease, perceptions about vaccine safety and efficacy, and the strength of endorsements by providers and other trusted opinion leaders. Among the most important considerations were that the factors listed above would vary between states and population segments, and that the communication environment would remain dynamic, elevating the importance of the role of local partners. All of these planning assumptions proved to be true, and additional insights were gained.  Raising awareness of the unpredictability and potential danger of the new influenza virus while reassuring the public that the new vaccine is very safe, proved to be a challenging balancing act.

Implications for research and/or practice:  There are a number of broad implications or lessons learned from CDC’s experience planning, implementing, and evaluating a campaign to promote H1N1 vaccination in such a challenging communication environment, including: 1) sound communication principles, the practical experience and knowledge of health communication staff, and ongoing audience research can be trusted to serve as a compass in the most challenging health communication environments; 2) in such environments, the ability and willingness to adjust the best laid plans, approaches, messages, and materials as needed is critical; 3) communication efforts during disease outbreaks that impact the entire country or spread globally must take into account local variation; and 5) communication among partners must be frequent and candid to help ensure coordination and consistency and reduce duplication of effort.